National Medical Director – UM Job Description Template

Growing integrated healthcare provider seeks a National Medical Director to lead the company’s utilization management clinical team. This is a remote role with associated travel, so candidates can live in any US city with easy access to major airport.

typical roles and responsibilities for National Medical Director – UM

• Oversee utilization management team activities including reviewing requests and making coverage determinations for services and supplies for delegated lines of business.
• Act in a leadership role as medical manager and policy advisor to the company and clients.
• Executes the Utilization/Cost Management Programs and relevant Clinical Quality Improvement Programs in partnership with the company leadership
• Interfaces with provider community on Utilization Management and evidence-based medicine
• Provides education to provider teammates in local markets and to the UM team regarding managed care processes as well as clinical issue 

Requirements for National Medical Director – UM Physician

• M.D. graduate of an accredited medical school, MBA or advanced degree in healthcare management preferred
• U.S. M.D. licensure, board certified in internal medicine, family medicine or primary care.
• 5+ years’ experience as a physician reviewer performing peer review activities.
• 2+ years managing UM team, including regional UM physicians
• Experience with the dual eligible Medicare / Medicaid population
• 3+ years post residency experience in clinical practice
• Progressive medical administration experience strongly preferred
• Proven ability in a medical leadership position in clinical credibility with experience developing and guiding team members
• A strong understanding of all aspects of managed care, including HMOs, PHOs, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, pharmacy management, and patient centered medical home concepts.
• Strong interpersonal, verbal, and written communication skills.
• The ability to navigate in a corporate matrix environment